| Raoul G Biniaurishvili Md Pc | |
|
11685-c Bustleton Ave Hendrix Center Philadelphia PA 19116-2542 | |
| (215) 464-7820 | |
| (215) 464-7808 |
| Full Name | Raoul G Biniaurishvili Md Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 11685-c Bustleton Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Raoul G Biniaurishvili (CEO) |
| Authorized Official Contact | 2154647820 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Raoul G Biniaurishvili Md Pc 170 Christopher Dr Princeton NJ 08540-2322 Ph: (609) 497-7576 | Raoul G Biniaurishvili Md Pc 11685-c Bustleton Ave Hendrix Center Philadelphia PA 19116-2542 Ph: (215) 464-7820 |
| NPI Number | 1912164401 |
|---|---|
| Provider Enumeration Date | 05/21/2008 |
| Last Update Date | 05/21/2008 |
| Medicare PECOS PAC ID | 2860564689 |
|---|---|
| Medicare Enrollment ID | O20080710000320 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912164401 | NPI | - | NPPES |
| 0014094500003 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | MD048245L (Pennsylvania) | Primary |
| 2084S0012X | Psychiatry & Neurology - Sleep Medicine | MD048245L (Pennsylvania) | Secondary |
| Provider Name | Raoul G Biniaurishvili |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1851326466 PECOS PAC ID: 2365514171 Enrollment ID: I20080710000283 |
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